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Endoscopic total arytenoidectomy for bilateral abductor vocal fold paralysis: a new flap technique and personal experience with 50 cases.
Laryngoscope. 2012 Oct; 122(10):2219-26.L

Abstract

OBJECTIVES/HYPOTHESIS

Bilateral vocal fold paralysis is a very serious complication of thyroid surgery, with resulting airway obstruction, aspiration, swallowing disturbance, and voice change. When treated with endoscopic total arytenoidectomy, airway obstruction may be relieved; however, there are concerns that voice may be seriously and irreversibly damaged and aspiration may become a permanent problem.

STUDY DESIGN

Prospective, cohort study.

METHODS

Fifty patients with bilateral vocal fold paralysis underwent endoscopic total arytenoidectomy, medially based mucosal advancement flap, and vocal fold lateralization with endoscopic microsuture. Pre- and postoperative evaluations included Voice Handicap Index (VHI-30), aerodynamic and acoustic analysis, subjective comparison of pre- and postoperative voice by phoniatrician, speech intensity measurement, breathing ability evaluation, and functional outcome swallowing scale.

RESULTS

All VHI-30 results, all aerodynamic analysis results, and all acoustic results (except F0) worsened significantly after surgery (P < .05). Subjective comparison of pre- and postoperative voice by phoniatrician revealed somewhat worse voice (94%). Mean speech intensity decreased from 65 dB to 60 dB postoperatively (P < .05). Postoperative breathing ability was significantly better (90%). The pre- and postoperative functional outcome swallowing scales were not significantly different (P > .05).

CONCLUSIONS

Endoscopic total arytenoidectomy is still a very successful static surgical option for bilateral vocal fold paralysis. It is performed without a tracheotomy, but may be required in some patients postoperatively. Laser is not a requirement for it, and it can easily be done with cold instruments. It attains comfortable airway with acceptable voice. Postoperatively, it does not increase aspiration significantly. It has good long-term results.

Authors+Show Affiliations

Hacettepe University Faculty of Medicine, Department of Otolaryngology, Ankara, Turkey. tyilmaz@hacettepe.edu.tr

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22865083

Citation

Yilmaz, Taner. "Endoscopic Total Arytenoidectomy for Bilateral Abductor Vocal Fold Paralysis: a New Flap Technique and Personal Experience With 50 Cases." The Laryngoscope, vol. 122, no. 10, 2012, pp. 2219-26.
Yilmaz T. Endoscopic total arytenoidectomy for bilateral abductor vocal fold paralysis: a new flap technique and personal experience with 50 cases. Laryngoscope. 2012;122(10):2219-26.
Yilmaz, T. (2012). Endoscopic total arytenoidectomy for bilateral abductor vocal fold paralysis: a new flap technique and personal experience with 50 cases. The Laryngoscope, 122(10), 2219-26. https://doi.org/10.1002/lary.23467
Yilmaz T. Endoscopic Total Arytenoidectomy for Bilateral Abductor Vocal Fold Paralysis: a New Flap Technique and Personal Experience With 50 Cases. Laryngoscope. 2012;122(10):2219-26. PubMed PMID: 22865083.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic total arytenoidectomy for bilateral abductor vocal fold paralysis: a new flap technique and personal experience with 50 cases. A1 - Yilmaz,Taner, Y1 - 2012/08/02/ PY - 2012/01/02/received PY - 2012/03/30/revised PY - 2012/05/04/accepted PY - 2012/8/7/entrez PY - 2012/8/7/pubmed PY - 2012/12/10/medline SP - 2219 EP - 26 JF - The Laryngoscope JO - Laryngoscope VL - 122 IS - 10 N2 - OBJECTIVES/HYPOTHESIS: Bilateral vocal fold paralysis is a very serious complication of thyroid surgery, with resulting airway obstruction, aspiration, swallowing disturbance, and voice change. When treated with endoscopic total arytenoidectomy, airway obstruction may be relieved; however, there are concerns that voice may be seriously and irreversibly damaged and aspiration may become a permanent problem. STUDY DESIGN: Prospective, cohort study. METHODS: Fifty patients with bilateral vocal fold paralysis underwent endoscopic total arytenoidectomy, medially based mucosal advancement flap, and vocal fold lateralization with endoscopic microsuture. Pre- and postoperative evaluations included Voice Handicap Index (VHI-30), aerodynamic and acoustic analysis, subjective comparison of pre- and postoperative voice by phoniatrician, speech intensity measurement, breathing ability evaluation, and functional outcome swallowing scale. RESULTS: All VHI-30 results, all aerodynamic analysis results, and all acoustic results (except F0) worsened significantly after surgery (P < .05). Subjective comparison of pre- and postoperative voice by phoniatrician revealed somewhat worse voice (94%). Mean speech intensity decreased from 65 dB to 60 dB postoperatively (P < .05). Postoperative breathing ability was significantly better (90%). The pre- and postoperative functional outcome swallowing scales were not significantly different (P > .05). CONCLUSIONS: Endoscopic total arytenoidectomy is still a very successful static surgical option for bilateral vocal fold paralysis. It is performed without a tracheotomy, but may be required in some patients postoperatively. Laser is not a requirement for it, and it can easily be done with cold instruments. It attains comfortable airway with acceptable voice. Postoperatively, it does not increase aspiration significantly. It has good long-term results. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/22865083/Endoscopic_total_arytenoidectomy_for_bilateral_abductor_vocal_fold_paralysis:_a_new_flap_technique_and_personal_experience_with_50_cases_ L2 - https://doi.org/10.1002/lary.23467 DB - PRIME DP - Unbound Medicine ER -